Vascular Surgery Headline Surgical Treatments of Swedish Heart - - PowerPoint PPT Presentation

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Vascular Surgery Headline Surgical Treatments of Swedish Heart - - PowerPoint PPT Presentation

Jan 11, 2024 367 likes •592 views

Vascular Surgery Headline Surgical Treatments of Swedish Heart & Vascular Institute Swedish Neuroscience Institute Parkinsons Disease Retreat Program title Presenter Rocco G. Ciocca, M.D. FACS Carter S. Gerard MD Neurosurgeon

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Headline

Swedish Neuroscience Institute

Program title

Presenter

title

Vascular Surgery

Swedish Heart & Vascular Institute

Retreat

Rocco G. Ciocca, M.D. FACS

Chief of Vascular Surgery

Surgical Treatments

  • f

Parkinson’s Disease

Carter S. Gerard MD Neurosurgeon Swedish Neuroscience Institute

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Swedish Neuroscience Institute

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Disclosures

  • None
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Swedish Neuroscience Institute

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  • Resting Tremor

– “Being even checked by the adoption of voluntary motion”

  • Gait

– “The legs are not raised to the height which the will directs”

  • Nonmotor Symptoms

– “The sleep becomes much disturbed” – “The bowels require stimulating medicines to function”

  • Bradykinesia and Rigidity

– Later described by Charcot

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Swedish Neuroscience Institute

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Environmental and Genetic Risk Factors

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Swedish Neuroscience Institute

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  • Prestereotactic Era (1890-1954)

– Surgeries involving the peripheral nervous system – Resection of precentral cortex – Open resection of the basal ganglia – 1950s- Cooper pioneered ligation of the anterior choroidal artery

  • Early Stereotactic Era (1947-1968)

– 1957 Cooper performs chemopallidectomies with procaine – Post mortem revealed thalamotomy in patient with significant tremor reduction

  • Latent/Levadopa Era(1968-1992)
  • Ablative Surgery Era (1992-1999)
  • Modern/DBS Era (1993-present)
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Swedish Neuroscience Institute

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title

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Swedish Neuroscience Institute

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Deep Brain Stimulation

  • 1950s -Deep brain stimulation

first described

  • 1968 – Development of

levadopa

  • 1987- Benabid and Pollock

reported VIM stimulation for Parkinson’s

  • 1993 - Benabid and Pollock

reported successful STN

N Engl J Med. 2014 Oct 9;371(15):1369-73. doi: 10.1056/NEJMp1408779. Epub 2014 Sep 8.

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Swedish Neuroscience Institute

Program title

Presenter

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Who Can It Help?

  • Confirmed Diagnosis Parkinson’s

Disease

  • Responding to L-Dopa with side effects
  • Absence of Dementia
  • No Untreated Depression
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Swedish Neuroscience Institute

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Presenter

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How Does it Work?

N Engl J Med. 2014 Oct 9;371(15):1369-73. doi: 10.1056/NEJMp1408779. Epub 2014 Sep 8.

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Swedish Neuroscience Institute

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What is the Goal?

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Swedish Neuroscience Institute

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What Are The Risks

  • Hemorrhage(<2%)
  • Infection(2-3%)
  • Seizure(1%)
  • Hardware malfunction(2-3%)
  • Stimulation side effects

– Motor – Cognitive – Depression/Anxiety – Speech – Balance

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Swedish Neuroscience Institute

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Presenter

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Stereotactic Technique

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Headline

Swedish Neuroscience Institute

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“Millimeters Matter..”

Stereotact Funct Neurosurg. 2009;87(5):297-303. doi: 10.1159/000230692. Epub 2009 Jul 29.s

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Swedish Neuroscience Institute

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Confirmation: Anatomic or Physiologic

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Headline

Swedish Neuroscience Institute

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Presenter

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Asleep Techniques

  • CT Verified

– Intraoperative CT

  • MRI Verified

– MRI prior to reversal of anesthesia

  • MRI Guided

– ClearPoint

J Neurosurg Pediatr. 2014 Oct;14(4):400-8. doi: 10.3171/2014.6.PEDS13605. Epub 2014 Aug 1.

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Swedish Neuroscience Institute

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Directional Leads

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Headline

Swedish Neuroscience Institute

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Future of DBS

  • Closed-loop stimulation
  • High resolution electrodes
  • Miniaturization
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Headline

Swedish Neuroscience Institute

Program title

Presenter

title

MR Guided Focus Ultrasound

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Headline

Swedish Neuroscience Institute

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Presenter

title

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Headline

Swedish Neuroscience Institute

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Convection Enhanced Delivery

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Headline

Swedish Neuroscience Institute

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title

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Headline

Swedish Neuroscience Institute

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